SSRI Antidepressants Linked to Intracranial Hemorrhage Risk: Study

New research suggests that individuals who take certain types of antidepressants, including blockbuster drugs like Paxil and Zoloft, may face an increased risk of suffering a brain bleed, especially if they are also taking certain blood thinners at the same time. 

In a study published last week in the medical journal JAMA Neurology, researchers from the Jewish General Hospital and McGill University found that a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) increase a person’s risk of spontaneous intracranial hemorrhage. That brain bleeding risk is further elevated if they are also taking certain anticoagulant drugs, such as Warfarin or Xarelto.

Researchers said prior studies have indicated side effects of SSRI antidepressants may increase the risk of bleeding. One study concluded SSRIs, like Paxil, Prozac, and Zoloft, doubled the risk of gastrointestinal bleeding. However, researchers wanted to study SSRIs compared to tricyclic antidepressants, or TCAs.

New users of antidepressants 18 years or older from more than 650 general practices in the United Kingdom were studied. Data was taken from Clinical Practice Research Datalink enrolled patients from January 1, 1995, to June 30, 2014. Follow-up was completed October 31, 2014.

More than 1.3 million users of antidepressants were studied compared with nearly 90,000 matching control patients. More than 3,000 cases of intracranial bleed were identified during follow-up.

The study’s authors found that current SSRI use was associated with a 25% increased risk for brain bleed compared to tricyclic antidepressants. The risk was the highest for SSRI users during the first 30 days of use.

Using SSRIs while also using anticoagulants increased the risk substantially, the researchers found. The risk of intracranial bleeds increased three-fold with the use of anticoagulants and SSRIs, compared to the use with TCAs, which didn’t reach statistical significance. Anticoagulants included Warfarin, Pradaxa, and Xarelto.

A study from 2011 also linked an increased risk of life-threatening bleed among patients taking SSRIs, like Zoloft or Paxil, along with anticoagulant drugs. Those patients faced a significantly increased risk of gastrointestinal bleed, hemorrhagic stroke and other problems.

SSRIs are among the most commonly prescribed medications in the U.S. Estimates from the National Health and Nutrition Examination Survey database indicate eight percent of U.S. adults 20 years and older were prescribed SSRIs in 2012.

In comparison, about one percent of U.S. adults were prescribed tricyclic antidepressants.